How Does Attachment Differ in Teens with ADHD and Oppositional Defiant Disorder?

What you need to know

• Teens with both ADHD and oppositional defiant disorder (ODD) show more insecure attachment patterns compared to teens with only ADHD or no diagnosis.
• Teens with ADHD and ODD report less trust, communication, and care in relationships with parents, and more alienation and control compared to teens with only ADHD.
• The anxious-avoidant attachment style is most common in teens with ADHD and ODD for both parental and peer relationships.

Understanding ADHD and Oppositional Defiant Disorder

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are conditions that affect behavior control in children and teens. ADHD involves difficulties with attention, hyperactivity, and impulsivity. ODD is characterized by a pattern of angry, irritable mood and defiant, argumentative behavior towards authority figures.

When ADHD and ODD occur together, it can significantly impact a young person’s relationships and functioning at home, school, and in social settings. This combination also increases the risk of developing more serious problems later in life.

The Importance of Attachment

Attachment refers to the emotional bond between a child and their caregivers. It plays a crucial role in shaping how we form relationships throughout our lives. Secure attachment develops when caregivers consistently respond to a child’s needs with warmth and sensitivity. This helps children feel safe to explore the world and develop healthy relationships.

Insecure attachment patterns can develop when caregivers are inconsistent, rejecting, or emotionally unavailable. This may lead to difficulties with emotion regulation, social skills, and behavior. Understanding attachment in teens with ADHD and ODD can provide insights into their relationship challenges and inform potential interventions.

How the Study Was Conducted

The researchers compared three groups of teenagers aged 13-16:

1. ADHD/ODD group: 40 teens diagnosed with both ADHD and ODD
2. ADHD group: 40 teens diagnosed with only ADHD
3. Control group: 40 teens without any psychiatric diagnosis

All participants were raised in their biological families. The study used two questionnaires to assess attachment:

1. The Inventory of Parent and Peer Attachment (IPPA): This measures trust, communication, and alienation in relationships with mothers, fathers, and peers.

2. The Parental Bonding Instrument (PBI): This assesses care and control in relationships with parents.

Key Findings: Attachment to Parents

Mother Attachment

• Trust: The ADHD/ODD group reported significantly less trust in their relationship with their mother compared to both the ADHD-only and control groups.
• Communication: Teens with ADHD/ODD reported poorer communication with their mothers compared to the other two groups.
• Alienation: The ADHD/ODD group felt more alienated from their mothers than both the ADHD-only and control groups.
• Care: Teens with ADHD/ODD perceived less care from their mothers compared to the other groups.
• Control: The ADHD/ODD group reported higher levels of control from their mothers than the other groups.

Interestingly, there were no significant differences between the ADHD-only group and the control group in these areas of mother attachment.

Father Attachment

• Trust: Both the ADHD/ODD and ADHD-only groups reported less trust in their relationship with their father compared to the control group. The ADHD/ODD group had the lowest levels of trust.
• Communication: The ADHD/ODD group reported poorer communication with their fathers compared to both other groups.
• Alienation: Teens with ADHD/ODD felt more alienated from their fathers than both other groups.
• Care: The ADHD/ODD group perceived less care from their fathers compared to the other groups. The ADHD-only group also reported less care than the control group.
• Control: Both the ADHD/ODD and ADHD-only groups reported higher levels of control from their fathers than the control group, with the ADHD/ODD group experiencing the most control.

Attachment Styles with Parents

Based on these findings, the researchers classified the teens’ attachment styles:

Mother Attachment Styles

• ADHD/ODD group: 70% anxious-avoidant, 17.5% anxious-ambivalent, 12.5% secure
• ADHD-only group: 47.5% secure, 35% anxious-ambivalent, 17.5% anxious-avoidant
• Control group: 87.5% secure, 7.5% anxious-ambivalent, 5% anxious-avoidant

Father Attachment Styles

• ADHD/ODD group: 85% anxious-avoidant, 7.5% anxious-ambivalent, 7.5% secure
• ADHD-only group: 47.5% anxious-avoidant, 27.5% anxious-ambivalent, 25% secure
• Control group: 55% secure, 30% anxious-ambivalent, 15% anxious-avoidant

These results show that teens with both ADHD and ODD are much more likely to have insecure attachment styles, particularly anxious-avoidant attachment, compared to teens with only ADHD or no diagnosis.

Peer Attachment Findings

The study also examined attachment to peers:

• Trust: Both the ADHD/ODD and ADHD-only groups reported significantly less trust in peer relationships compared to the control group.
• Communication: Both clinical groups reported poorer communication with peers than the control group.
• Alienation: The ADHD/ODD and ADHD-only groups felt more alienated from peers than the control group.

There were no significant differences between the ADHD/ODD and ADHD-only groups in peer attachment.

Peer Attachment Styles

• ADHD/ODD group: 82.5% anxious-avoidant, 10% anxious-ambivalent, 7.5% secure
• ADHD-only group: 72.5% anxious-avoidant, 17.5% anxious-ambivalent, 10% secure
• Control group: 40% secure, 35% anxious-ambivalent, 25% anxious-avoidant

These findings highlight that teens with ADHD, regardless of whether they also have ODD, struggle more with peer relationships compared to teens without these conditions.

Understanding the Impact

The high prevalence of insecure attachment styles, particularly anxious-avoidant attachment, in teens with ADHD and ODD has several important implications:

1. Emotion regulation: Insecure attachment can make it harder for teens to manage their emotions effectively. This may contribute to the behavioral challenges associated with ADHD and ODD.

2. Social skills: Difficulties trusting others and communicating effectively can lead to problems forming and maintaining friendships. This may explain some of the social challenges often experienced by teens with ADHD and ODD.

3. Behavioral problems: The combination of poor emotion regulation, social difficulties, and feelings of alienation may contribute to the development and maintenance of oppositional and defiant behaviors.

4. Parenting challenges: The higher levels of control reported by teens with ADHD and ODD may reflect parents’ attempts to manage difficult behaviors. However, this approach might inadvertently reinforce insecure attachment patterns.

5. Treatment implications: Understanding attachment patterns can help inform more effective interventions for teens with ADHD and ODD. Approaches that focus on improving parent-child relationships and fostering secure attachment may be beneficial.

Conclusions

• Teens with both ADHD and ODD show significantly different attachment patterns compared to teens with only ADHD or no diagnosis.
• Insecure attachment styles, particularly anxious-avoidant attachment, are much more common in teens with ADHD and ODD for both parent and peer relationships.
• Attachment difficulties may play a role in the development and maintenance of behavioral problems in teens with ADHD and ODD.

This research highlights the importance of considering attachment in the assessment and treatment of teens with ADHD and ODD. Interventions that focus on improving parent-child relationships and fostering more secure attachment patterns may be valuable additions to standard treatments for these conditions. Future research could explore whether targeting attachment can lead to improvements in symptoms and overall functioning for teens with ADHD and ODD.